Tire Road Hazard Warranty Registration Form

Customer-facing form to register road-hazard warranty coverage at the time of tire purchase and capture tire DOT codes, purchase details, and vehicle information.

Customer Information

• Full Name
• Email Address
• Phone Number
  Optional. Used only if we need to contact you about your warranty registration or a claim.
• Consent to Use My Information for Warranty Administration
  By submitting this form, you consent to the collection and use of your contact information, vehicle details, and tire DOT codes for warranty registration, coverage verification, and claims support.

Purchase Details

• Purchase Date
• Purchase Location
• Invoice or Receipt Number
• Warranty Plan

Tire Details

• Number of Tires Covered
• Tire Details
• DOT Code Guidance
  Enter the full DOT code from each tire sidewall. Do not abbreviate or enter only the last four digits.

Vehicle Information

• Vehicle Make
• Vehicle Model
• Vehicle Year
• Last 8 Characters of VIN
  Optional. Use only if needed to match the warranty record to the vehicle.